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Renal I > Renal Function Testing and Urinalysis - Gustafson > Flashcards

Renal Function Testing and Urinalysis - Gustafson Flashcards

1
Q

Urea

A

BUN - blood urea nitrogen
Normal 8-25 mg/dl
Body’s way of disposing of ammonia
Urea filtered by glomerulus

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2
Q

When blood flow is low, what happened to urea?

A

Tends to be reabsorbed passively. Rises faster than creatinine when the kidney is underperfused

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3
Q

3 Types of azotemia

A

Prerenal - kidney is underperfused - 20/1
Renal - the kidney is damaged - < 10
Postrenal

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4
Q

What can cause an increased BUN?

A

Increased protein catabolism
Diet high in protein
Upper GI bleed
Physiological stress

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5
Q

Potential causes of pre renal azotemia

A

Dehydration
Hemorrhage/shock
Congestive heart failure
Liver failure - hepatorenal syndrome

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6
Q

What can cause renal azotemia

A

Acute renal injury
Medications
Acute kidney disease
Chronic kidney disease

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7
Q

What can cause post-renal azotemia

A

Urine is blocked

  • prostatism
  • stone
  • injury
  • stone
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8
Q

What can cause decreased BUN?

A

Protein malabsorption
Protein wasting - nephrotic syndrome
Liver failure
Overhydration

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9
Q

Creatinine

A

Breakdown of creatine phosphate, released from skeletal m
Normal 0.6-1.3 gm/dL (up to 2.0 in body builder)
Filtered by glomerulus and secreted by the tubules

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10
Q

Increased creatinine

A 
A sensitive marker for kidney failure
Huge muscle mass
Medications
Cooked meat
Rhabdomyolysis
Does NOT require 24 hour collection
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11
Q

What is the classic estimate of glomerular filtration rate?

A

Creatinine clearance

Normal - 90-120 mL/min

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12
Q

What GRF lab result is associated with chronic kidney disease?

A

Below 90 mL/min

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13
Q

Cystatin C

A

Gamma trace protein

Produced by all nucleated cells and is superior to creatinine

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14
Q

What is the urine sodium concentration in pre renal azotemia/shock/hepatorenal syndrome?

A

< 20 mEq/L

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15
Q

What is urine sodium concentration in acute renal injury?

A

> 40 mEq/L

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16
Q

FENa calculation

A

Urine Na x Serum Cr / Serum Na x Urine Cr

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17
Q

FENa values for pre renal azotemia and acute renal injury

A

DUBE was a huge fan of this
Prerenal azotemia - < 1%
Acute renal injury > 2%

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18
Q

What are 3 ways to estimate specific gravity?

A

Hydrometer (urineometer)
Refractometer
Dipstick

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19
Q

How do you measure the osmolality of urine in the lab?

A

Using an osmometer

20
Q

Lab values in acute renal injury

A

SG - 1.010

Osmolality close to plasma - 300 mOsm/Kg

21
Q

Lab values in pre renal azotemia

A

SG high

Osmolality > 500 mOsm/Kg

22
Q

Polyuria

A

Urine > 3 L/day

If osmolality > 300mOsm pt has a solute diuresis (probably glucose or ketone)

23
Q

What effect can bacteria have on a urine specimen?

A

Zero glucose
Alkaline urine
Vanished formed elements

24
Q

What does cloudy urine mean?

A

Lots of white cells due to infection
OR
Harmless crystals that are forming as it cools

25
Q

Red urine can be caused by what 4 things?

A

Blood
Myoglobin
Porphyria
Beets

26
Q

What does yellow fluorescence in urine indicate?

A

Heavily loaded with riboflavin (Vit B)

27
Q

What does a foamy head on a urine sample indicate?

A

Usually proteinuria or conjugated bilirubinuria

28
Q

What is the SG for dilute urine and what can it indicate?

A

< 1.007
Diabetes insipidus
Or pt drank shit ton o’ water

29
Q

Isosthenuria

A

SG stuck at 1.010

Suggests renal tubules are not working

30
Q

pH

A

Important for crystal analysis

31
Q

If you are acutely sick, how much protein is it normal to have in your urine?

A

Trace

32
Q

Ketones

A

Low levels - missed a meal
High - diabetic ketoacidosis
L-Dopa can cause a positive test

33
Q

Asymptomatic hematuria is indicative of what?

A

Kidney or bladder cancer until proven otherwise

34
Q

Possible causes of myoglobinuria?

A

Muscle injury, overexertion or rhabdomyolysis

35
Q

Nitrite

A

A metabolite of bacterial metabolism

36
Q

What type of bilirubin will make it into the urine?

A

Conjugated

The unconjugated form isn’t water soluble

37
Q

Elevated urobilinogen indicates?

A

Either too much bilirubin being put out (your hemolyzing) The urobilinogen from color is sneaking past liver

38
Q

What pad on the dipstick is useful for picking up bacterial UTIs?

A

The Leukocyte alkaline esterase

-each spot is a neutrophil

39
Q

RBCs come from where?

A

Glomerular bleeding

40
Q

What makes glitter cells in the urine?

A

White cells - brownian movement

41
Q

What can indicate that a urine sample has been contaminated?

A

Vaginal squamous cells
Pollen
Candida

42
Q

Tamm-Horsfall protein

A

A glycoprotein made by the tubules

A few hyaline casts made of this are normal

43
Q

Epithelial cell casts indicate what disease?

A

Acute tubular necrosis

44
Q

What are common causes of oxalate crystals?

A 
Stones
Vit C
Antifreeze
Spinach
Crohns
45
Q

What indicates that you have a urea splitter infection?

A

Magnesium ammoniam phosphate crystals

46
Q

Leucine bicycle wheels indicate?

A

Liver failure

Renal I (20 decks)

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